Genital warts

Diagnosis

The healthcare provider begin the diagnosis with an examination. External warts that are visible can be diagnosed right away. In some cases, especially if the location is difficult to identify, the doctor may require a biopsy.

• Pap tests: Preventive healthcare services for women such as pelvic exams and pap smears are vital to monitor and identify vaginal and cervical abnormalities brought on by genital warts or the early stages of cervical cancer. The doctor may conduct a colposcopy to evaluate the cervix and vagina and taking a biopsy. Pap smear is done by using a speculum to hold the vagina open so that the doctor can see the channel between the vagina and uterus.
• HPV test: The major cause of cervical cancer are HPV types 16 and 18. During a Pap test, the doctor takes cells from the cervix to check for any abnormalities, including if they are cancerous or potentially cancerous.

HPV would eventually be cured if the person, usually younger women, has a strong immune system that can eliminate the virus or inhibit it over time. Therefore, doctors often recommend HPV test for women ages 30 and older.

Treatment

The treatment for genital warts depends on what the warts are like, where they are located and other factors such as one’s existing health condition. However, since there is no permanent cure for HPV, warts can still recur after the treatment. The warts get treated but the virus that causes the warts remains with the infected person.

Several methods, usually in form of medications or surgery, are used to treat genital warts. Some people who were tested positive for HPV but has no visible warts can talk to their healthcare provider about measures to effectively manage the infection and avoid passing it to their partners.

Medications

There are many available treatments, in form of creams or liquid, that can be applied directly to the genital wart, these are:

• Imiquimod (Aldara, Zyclara): This cream is applied directly to the wart (often at night) and is left for about six to ten hours before washing the area with water. It aims to stimulate the immune system to eliminate the wart. It is recommended to avoid having an intercourse while the cream is on the skin. It can cause the partner’s skin to become irritated and weaken condoms and diaphragms. This cream is not advisable for pregnant women,

For Aldara, the application of the cream is three days per week up to 16 weeks, while Zyclara requires daily application for up to eight weeks. Common side effects of imiquimod include mild irritation, redness, body aches, fatigue or cough which indicates that the medication is working.

• Podophyllin and podofilox: These gel-type or liquid solution medication targets to kill the tissue of genital warts. Podofilox can be applied at home, while podophyllin is applied by a healthcare provider. Podophyllin requires weekly application for four to six weeks or until the warts are gone. Podofilox solution is for external use only and is applied two times a day for three consecutive days. Then, abstain medication for four days and repeat the process until the warts have cleared. Both medications are not recommended for use during pregnancy. Common side effects are mild skin irritation, pain, and skin ulcers.
• Bichloracetic acid (BCA) and trichloroacetic acid (TCA): These acids are recommended to remove internal warts and is safe to use by pregnant women. It targets in dissolving the tissue of the warts. Between the two, TCA is commonly used. For four to six weeks, or until the warts disappear, the healthcare provider sprays acid to the wart once a week. TCA might cause irritation, burning and pain as side effects.
• Sinecatechins: This is a botanical ointment that can be applied without assistance from a healthcare provider. It contains catechins, a potent antioxidant and is known to have immune-boosting properties. This treatment is generally used for external warts. For up to 16 weeks, the ointment is applied to each wart three times a day. It is not recommended for use in the vagina, anus, people with active herpes and immunocompromised individuals. Abstain from sexual contact while on medication or wash it off before having an intercourse. Common side effects can range from mild to severe such as itching, redness, pain, inflammation, ulceration, swelling, burning and small blisters.
• Interferon: This medication is typically used in conjunction with surgical procedures and if initial medications were ineffective. This drug stimulates one’s immune system. It is topically administered as a gel or as an injection into the wart. Side effects are flu-like symptoms, loss of appetite and soreness.

Common warts and genital warts require different treatments. Home remedies and over-the-counter medications for common warts may not be advisable for genital warts. Seek professional medical advice before using any medication.

Surgery

Surgical treatments may be recommended for warts that are larger, unresponsive to medications, located in the vagina, urethra or anus and areas that have precancerous changes. Surgery is generally safe in pregnant women.

Common surgical treatments are:

• Cryotherapy: This is a method of destroying the warts by freezing them using liquid nitrogen. The ensuing dead tissue can be shed off a week or so later. Repeated sessions may be necessary, usually every week for 4 weeks. Pain is a common adverse effect of cryotherapy, and it can also cause skin irritation, edema, blistering, and ulceration. Anesthesia is not required during the procedure.
• Electrocautery: This procedure is done is an operating room using local anesthesia. It burns the warts tissue using electrical energy. After the procedure, the patient may experience swelling and pain.
• Surgical excision: Genital warts that are visible can be removed through excision. The doctor may use a surgical knife or scalpel to cut off the warts. In cases where the warts are in the female’s cervix, a method called loop electrosurgical excision procedure (LEEP) is used. An insulated wire loop is heated by electricity and used to cut away the abnormal tissue. After the excision, the patient may feel pain and lightheadedness. This procedure is done under local or general anesthesia.
• Laser treatments: This treatment is recommended for warts that are multiple, widespread, and difficult to treat. Genital warts are destroyed by the powerful light energy produced by lasers. It cuts off the blood supply of tiny blood vessels inside the warts.

Only specialized and trained doctors are allowed to administer laser therapy. Local anesthesia is used during treatment to minimize pain. Patients may experience pain, scarring and changes in skin color after the therapy.

Successful treatment does not mean that the HPV is gone. Warts can potentially recur months or years after the treatment. This is common to patients with weakened immune system. In some cases, a healthy body may clear the virus over time. Lifestyle changes may be necessary. People with HPV can ask a healthcare provider on how to increase their chances of clearing the virus.